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Ciociola EC, Sekimitsu S, Smith S, Lorch AC, Miller JW, Elze T, Zebardast N. Racial Disparities in Glaucoma Vision Outcomes and Eye Care Utilization: An IRIS Registry Analysis. Am J Ophthalmol 2024; 264:194-204. [PMID: 38548127 DOI: 10.1016/j.ajo.2024.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 05/09/2024]
Abstract
PURPOSE To evaluate racial disparities in vision outcomes and eye care utilization among glaucoma patients. DESIGN Retrospective cohort study. METHODS In this population-based IRIS Registry (Intelligent Research in Sight) study, we included patients with minimum one diagnosis code for glaucoma at least 6 months prior to January 1, 2015 and at least one eye exam, visual field (VF), optical coherence tomography (OCT), or eye-related inpatient or emergency department (ED) code in 2015. Multivariable logistic and negative binomial regression models were used to assess vision and utilization outcomes, respectively, across race and ethnicity from January 1, 2015 to January 1, 2020. Vision outcomes included cup-to-disc ratio (CDR) progression > 0.80, poor vision (visual acuity 20/200 or worse), low vision codes, and need for glaucoma filtering surgery. Utilization outcomes included outpatient eye exams, OCTs, VFs, inpatient/ED encounters, and lasers/surgeries. RESULTS Among 996,297 patients, 73% were non-Hispanic White, 15% non-Hispanic Black, 9% Hispanic, 3% Asian/Pacific Islander, and 0.3% Native American/Alaska Native. Compared to White eyes, Black and Hispanic eyes had higher adjusted odds of CDR progression (odds ratio [OR] = 1.12, 95% confidence interval [CI] = 1.08-1.17; OR = 1.28, 95% CI = 1.22-1.34), poor vision (OR = 1.26, 95% CI = 1.22-1.29; OR = 1.26, 95% CI = 1.22-1.31), glaucoma filtering surgery (rate ratio (RR) = 1.47, 95% CI = 1.42-1.51; RR = 1.13, 95% CI = 1.09-1.18). Hispanic eyes also had increased odds of low vision diagnoses (Hispanic OR = 1.18, 95% CI = 1.07-1.30). Black and Hispanic patients were less likely to have eye exams (RR = 0.94, 95% CI = 0.94-0.95; RR = 0.99, 95% CI = 0.99-0.99) and OCTs (RR = 0.86, 95% CI = 0.85-0.86; RR = 0.97, 95% CI = 0.96-0.98), yet Black patients had higher odds of inpatient/ED encounters (RR = 1.64, 95% CI = 1.37-1.96) compared to White patients. Native American patients were more likely to have poor vision (OR = 1.17, 95% CI = 1.01-1.36) and less likely to have outpatient visits (RR = 0.89, 95% CI = 0.86-0.91), OCTs (RR = 0.85, 95% CI = 0.82-0.89), visual fields (RR = 0.91, 95% CI = 0.88-0.94) or lasers/surgeries (RR = 0.87, 95% CI = 0.79-0.96) compared to White patients. CONCLUSIONS We found that significant disparities in US eye care exist with Black, Hispanic, and Native American patients having worse vision outcomes and less disease monitoring. Glaucoma may be undertreated in these racial and ethnic minority groups, increasing risk for glaucoma-related vision loss.
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Affiliation(s)
- Elizabeth C Ciociola
- From the Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins (E.C.C.), Baltimore, Maryland, USA
| | - Sayuri Sekimitsu
- Tufts University School of Medicine (S.S., S.S.), Boston, Massachusetts, USA
| | - Sophie Smith
- Tufts University School of Medicine (S.S., S.S.), Boston, Massachusetts, USA
| | - Alice C Lorch
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA (A.C.L., J.W.M., T.E., N.Z., J.W.M., A.L.)
| | - Joan W Miller
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA (A.C.L., J.W.M., T.E., N.Z., J.W.M., A.L.)
| | - Tobias Elze
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA (A.C.L., J.W.M., T.E., N.Z., J.W.M., A.L.)
| | - Nazlee Zebardast
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA (A.C.L., J.W.M., T.E., N.Z., J.W.M., A.L.).
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Ter-Minassian M, DiNucci AJ, Barrie IS, Schoeplein R, Chakravarty A, Hernández-Muñoz JJ. Improving data capture of race and ethnicity for the Food and Drug Administration Sentinel database: a narrative review. Ann Epidemiol 2023; 86:80-89.e2. [PMID: 37479122 DOI: 10.1016/j.annepidem.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 07/06/2023] [Accepted: 07/14/2023] [Indexed: 07/23/2023]
Abstract
PURPOSE The U.S. Food and Drug Administration's Sentinel System is a national medical product safety surveillance system consisting of a large multisite distributed database of administrative claims supplemented by electronic health-care record data. The program seeks to improve data capture of race and ethnicity for pharmacoepidemiology studies. METHODS We conducted a narrative literature review of published research on data augmentation and imputation methods to improve race and ethnicity capture in U.S. health-care systems databases. We focused on methods with limited (five-digit ZIP codes only) or full patient identifiers available to link to external sources of self-reported data. We organized the literature by themes: (1) variation in data capture of self-reported data, (2) data augmentation from external sources of self-reported data, and (3) imputation methods, including Bayesian analysis and multiple regression. RESULTS Researchers reduced data missingness with high validity for Asian, Black, White, and Pacific Islander racial groups and Hispanic ethnicity. Native American and multiracial groups were difficult to validate due to relatively small sample sizes. CONCLUSIONS Limitations on accessible self-reported data for validation will dictate methods to improve race and ethnicity data capture. We recommend methods leveraging multiple sources that account for variations in geography, age, and sex.
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Affiliation(s)
| | | | | | - Ryan Schoeplein
- Harvard Pilgrim Health Care Institute, Harvard Medical School Department of Population Medicine, Boston, MA
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Gillette C, Locklear T, Bell R, Bates N, Ostermann J, Reuland D, Foley K, Lashmit C, Crandall S. American Indian/Alaska Native men are less likely to receive prostate-specific antigen testing and digital rectal exams from primary care providers than White men: a secondary analysis of the National Ambulatory Medical Care Survey from 2012-2018. Cancer Causes Control 2023:10.1007/s10552-023-01714-x. [PMID: 37217700 PMCID: PMC10363029 DOI: 10.1007/s10552-023-01714-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 05/04/2023] [Indexed: 05/24/2023]
Abstract
PURPOSE (1) Identify the proportion of primary care visits in which American Indian/Alaska Native (AI/AN) men receive a prostate-specific antigen test (PSAT)and/or a digital rectal exam (DRE), (2) describe characteristics of primary care visits in which AI/AN receive PSA and/or DRE, and (3) identify whether AI/AN receive PSA and/or DRE less often than non-Hispanic White (nHW) men. METHODS This was a secondary analysis of the National Ambulatory Medical Care Survey (NAMCS) during 2013-2016 and 2018 and the NAMCS Community Health Center (CHC) datasets from 2012-2015. Weighted bivariate and multivariable tests analyzed the data to account for the complex survey design. RESULTS For AI/AN men, 1.67 per 100 visits (95% CI = 0-4.24) included a PSATs (or PSAT) and 0 visits included a DRE between 2013-2016 and 2018. The rate of PSA for non-AI/AN men was 9.35 per 100 visits (95% CI = 7.78-10.91) and 2.52 per 100 visits (95% CI = 1.61-3.42) for DRE. AI/AN men were significantly less likely to receive a PSA than nHW men (aOR = 0.09, 95% CI = 0.01-0.83). In CHCs, AI/AN men experienced 4.26 PSAT per 100 visits (95% CI = 0.96-7.57) compared to 5.00 PSAT per 100 visits (95% CI = 4.40-5.68) for non-AI/AN men. DRE rates for AI/AN men was 0.63 per 100 visits (95% CI = 0-1.61) compared to 1.05 per 100 (95% CI = 0.74-1.37) for non-AI/AN men. There was not a statistically significant disparity in the CHC data regarding PSA (OR = 0.91, 95% CI = 0.42-1.98) or DRE (OR = 0.75, 95% CI = 0.15-3.74), compared to nHW men. CONCLUSION Efforts are needed to better understand why providers may not use PSA and DRE with AI/AN men compared to nHW men.
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Affiliation(s)
- Chris Gillette
- Department of PA Studies, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC, 27157, USA.
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Tony Locklear
- Department of Public Health Education, School of Health and Human Sciences, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Ronny Bell
- Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Nathan Bates
- Department of PA Studies, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC, 27157, USA
| | - Jan Ostermann
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Daniel Reuland
- Department of General Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Kristie Foley
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Cheyenne Lashmit
- High Point Family Practice, Atrium Health Wake Forest Baptist, High Point, NC, USA
| | - Sonia Crandall
- Department of PA Studies, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC, 27157, USA
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Williams JH, Silvera GA, Lemak CH. Learning Through Diversity: Creating a Virtuous Cycle of Health Equity in Health Care Organizations. Adv Health Care Manag 2022; 21:167-189. [PMID: 36437622 DOI: 10.1108/s1474-823120220000021009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
In the US, a growing number of organizations and industries are seeking to affirm their commitment to and efforts around diversity, equity, and inclusion (DEI) as recent events have increased attention to social inequities. As health care organizations are considering new ways to incorporate DEI initiatives within their workforce, the anticipated result of these efforts is a reduction in health inequities that have plagued our country for centuries. Unfortunately, there are few frameworks to guide these efforts because few successfully link organizational DEI initiatives with health equity outcomes. The purpose of this chapter is to review existing scholarship and evidence using an organizational lens to examine how health care organizations can advance DEI initiatives in the pursuit of reducing or eliminating health inequities. First, this chapter defines important terms of DEI and health equity in health care. Next, we describe the methods for our narrative review. We propose a model for understanding health care organizational activity and its impact on health inequities based in organizational learning that includes four interrelated parts: intention, action, outcomes, and learning. We summarize the existing scholarship in each of these areas and provide recommendations for enhancing future research. Across the body of knowledge in these areas, disciplinary and other silos may be the biggest barrier to knowledge creation and knowledge transfer. Moving forward, scholars and practitioners should seek to collaborate further in their respective efforts to achieve health equity by creating formalized initiatives with linkages between practice and research communities.
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Domingues AM, Moertel CL, Marcotte EL. The Role of Socioeconomic Status and Race/Ethnicity in Malignant Peripheral Nerve Sheath Tumor Survival: A Surveillance, Epidemiology, and End Results-Based Analysis. Cancer Epidemiol Biomarkers Prev 2022; 31:1830-1838. [PMID: 35437584 PMCID: PMC9444868 DOI: 10.1158/1055-9965.epi-21-0997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/25/2021] [Accepted: 03/17/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Recent investigations of malignant peripheral nerve sheath tumor (MPNST) survival have reported higher mortality among non-White individuals. However, previous analyses have not examined the impact of socioeconomic status (SES) on these observations. This study aims to characterize factors associated with cause-specific MPNST survival, including information related to census-tract-level SES (CT-SES). METHODS We identified 2,432 primary MPNSTs using the Surveillance, Epidemiology, and End Results (SEER) 18 (2000-2016) database. We used Cox proportional hazards modeling to estimate the effects of sex, race/ethnicity, CT-SES quintile, metastasis at diagnosis, tumor site, age at diagnosis, and treatment by surgery on survival. Models were fit in both the full population and, separately, stratified by race/ethnicity and age at diagnosis (<40 vs. ≥40). RESULTS In adjusted models, age at diagnosis, CT-SES, and metastasis at diagnosis were associated with mortality. In race/ethnicity-stratified analysis, higher CT-SES was found to improve survival only in the White population. Among those diagnosed before age 40, metastasis at diagnosis and American Indian/Alaska Native race/ethnicity were associated with mortality, and both Hispanic ethnicity and Asian/Pacific Islander race were suggestive for increased mortality. Among cases, diagnoses at age 40 and above, age at diagnosis, male sex, and CT-SES were associated with mortality. CONCLUSIONS This analysis provides evidence that among pediatric and young adult patients, non-White populations experience inferior survival compared with Whites, independent of CT-SES. Our findings also suggest that the effect of CT-SES on MPNST survival may differ by racial/ethnic group. IMPACT These findings suggest that barriers to healthcare for certain racial/ethnic groups extend beyond SES.
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Affiliation(s)
- Allison M Domingues
- Division of Pediatric Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Christopher L Moertel
- Brain Tumor Program, University of Minnesota, Minneapolis, MN, USA,Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA,Pediatric Hematology and Oncology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Erin L Marcotte
- Division of Pediatric Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA,Brain Tumor Program, University of Minnesota, Minneapolis, MN, USA,Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
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Martino SC, Elliott MN, Klein DJ, Haas A, Haviland AM, Adams JL, Dembosky JW, Maksut JL, Gaillot SJ, Weech-Maldonado R. Disparities In The Quality Of Clinical Care Delivered To American Indian/Alaska Native Medicare Advantage Enrollees. Health Aff (Millwood) 2022; 41:663-670. [PMID: 35500179 DOI: 10.1377/hlthaff.2021.01830] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study used data from the 2019 Healthcare Effectiveness Data and Information Set (HEDIS) to examine differences in the quality of care received by American Indian/Alaska Native beneficiaries versus care received by non-Hispanic White beneficiaries enrolled in Medicare Advantage (managed care) plans. American Indian/Alaska Native beneficiaries were more likely than White beneficiaries to receive care that meets clinical standards for eight of twenty-six HEDIS measures and were less likely than White beneficiaries to receive care that meets clinical standards for five of twenty-six measures. Measures for which American Indian/Alaska Native beneficiaries were less likely to receive care meeting clinical standards were mainly ones pertaining to appropriate treatment of diagnosed conditions. In all cases, differences in care for American Indian/Alaska Native and White beneficiaries were largely within-plan differences. These findings indicate the need for improved clinical care for all beneficiaries. For American Indian/Alaska Native beneficiaries, there is a particular need for improvement in the treatment of diagnosed conditions, including diabetes, chronic obstructive pulmonary disease, and alcohol and other forms of substance abuse.
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Affiliation(s)
| | - Marc N Elliott
- Marc N. Elliott, RAND Corporation, Santa Monica, California
| | | | - Ann Haas
- Ann Haas, RAND Corporation, Santa Monica
| | - Amelia M Haviland
- Amelia M. Haviland, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - John L Adams
- John L. Adams, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | | | - Jessica L Maksut
- Jessica L. Maksut, Centers for Medicare and Medicaid Services, Baltimore, Maryland
| | - Sarah J Gaillot
- Sarah J. Gaillot, Centers for Medicare and Medicaid Services
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Woodward MA, Hughes K, Ballouz D, Hirth RA, Errickson J, Newman-Casey PA. Assessing Eye Health and Eye Care Needs Among North American Native Individuals. JAMA Ophthalmol 2022; 140:134-142. [PMID: 34940785 PMCID: PMC8855236 DOI: 10.1001/jamaophthalmol.2021.5507] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
IMPORTANCE There are few population-level studies on ophthalmic conditions and services among North American Native individuals. OBJECTIVE To evaluate whether disparities in ophthalmic conditions and services exist between North American Native individuals and non-Hispanic White individuals in the US. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used 100% Medicare fee-for-service (MFFS) enrollment data from the Vision and Eye Health Surveillance System (VEHSS) to examine ophthalmic conditions and service use in North American Native individuals and non-Hispanic White individuals in the US. In this study North American Native individuals included those who identified as American Indian, Native Alaskan, Native Hawaiian, and Pacific Islander. Data were analyzed from August 2020 to April 2021. INTERVENTIONS Claims and sociodemographic characteristics were extracted and means computed for categories of ophthalmic conditions and select ophthalmic services. Ophthalmic conditions and services were defined in the VEHSS using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Logistic regression was used to model differences between age-adjusted mean ophthalmic condition and service claim rates among North American Native individuals and non-Hispanic White individuals for each age cohort. Matching ophthalmic condition claim rates and ophthalmic service claim rates was performed to examine disparities by racial group. MAIN OUTCOMES AND MEASURES Mean age-adjusted claim rates for ophthalmic conditions and services among North American Native individuals vs non-Hispanic White individuals per 100 persons. RESULTS Claims were identified for 177 100 Native American Native individuals and 24 438 000 non-Hispanic White individuals. In 16 of 17 ophthalmic condition categories and 6 of 9 service categories, North American Native individuals had significantly different claim rates from non-Hispanic White individuals. There were higher ophthalmic condition claim rates but lower service claim rates for North American Native individuals (vs non-Hispanic White individuals) for refractive errors (ophthalmic condition, 17.2 vs 11.1; service, 48.3 vs 49.6, respectively; P < .001); blindness and low vision (ophthalmic condition, 1.48 vs 0.75: service, 19.2 vs 20.1, respectively; P < .001); injury, burns, and surgical complications (ophthalmic condition, 1.8 vs 1.7; service, 19.2 vs 20.1, respectively; P < .001); and orbital and external disease (ophthalmic condition, 15.7 vs 13.3; service, 48.3 vs 49.6, respectively; P < .001). For diabetic eye diseases, North American Native individuals had higher ophthalmic condition claim rates (5.22 vs 2.20) but no difference in service claim rates (14.4 vs 14.8; P = .26) compared with non-Hispanic White individuals. CONCLUSIONS AND RELEVANCE In this cross-sectional study, North American Native individuals had higher prevalence of ophthalmic conditions but no corresponding increase in services (treatment for most ophthalmic conditions) compared with non-Hispanic White individuals. These results suggest worse eye health and higher unmet eyecare needs for North American Native individuals with MFFS coverage compared with non-Hispanic White individuals with MFFS coverage.
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Affiliation(s)
- Maria A. Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | | | - Dena Ballouz
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
| | - Richard A. Hirth
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor,Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor
| | - Josh Errickson
- Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor
| | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
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Schneider EC, Chin MH, Graham GN, Lopez L, Obuobi S, Sequist TD, McGlynn EA. Increasing Equity While Improving the Quality of Care: JACC Focus Seminar 9/9. J Am Coll Cardiol 2021; 78:2599-2611. [PMID: 34887146 PMCID: PMC9172264 DOI: 10.1016/j.jacc.2021.06.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/02/2021] [Indexed: 01/14/2023]
Abstract
This review summarizes racial and ethnic disparities in the quality of cardiovascular care-a challenge given the fragmented nature of the health care delivery system and measurement. Health equity for all racial and ethnic groups will not be achieved without a substantially different approach to quality measurement and improvement. The authors adapt a tool frequently used in quality improvement work-the driver diagram-to chart likely areas for diagnosing root causes of disparities and developing and testing interventions. This approach prioritizes equity in quality improvement. The authors demonstrate how this approach can be used to create interventions that reduce systemic racism within the institutions and professions that deliver health care; attends more aggressively to social factors related to race and ethnicity that affect health outcomes; and examines how hospitals, health systems, and insurers can generate effective partnerships with the communities they serve to achieve equitable cardiovascular outcomes.
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Affiliation(s)
| | - Marshall H Chin
- University of Chicago, Section of General Internal Medicine, Chicago, Illinois, USA
| | - Garth N Graham
- Healthcare and Public Health, Google, Palo Alto, California, USA
| | - Lenny Lopez
- Division of Hospital Medicine, San Francisco VA Medical Center, University of California-San Francisco, Department of Medicine, San Francisco, California, USA
| | - Shirlene Obuobi
- Internal Medicine, University of Chicago, Section of Cardiology, Chicago, Illinois, USA
| | - Thomas D Sequist
- Division of General Medicine, Brigham and Women's Hospital, Department of Health Care Policy, Harvard Medical School, Department of Quality and Patient Experience, Mass General Brigham, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Elizabeth A McGlynn
- Kaiser Permanente, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA.
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Whitley JA, Kieran K. Geographic Variations in Pharmacy Services and Availability of Commonly Prescribed Pediatric Urology Medications: An Opportunity to Improve Health Equity in Washington State. Urology 2021; 165:285-293. [PMID: 34808141 DOI: 10.1016/j.urology.2021.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 09/29/2021] [Accepted: 10/13/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe geographic and sociodemographic variations in operating hours and availability of medications commonly prescribed by pediatric urologists at Washington State retail pharmacies. METHODS We identified all retail pharmacies in the state. We stratified counties by population density and household income (HI) and compared differences in pharmacy operating hours and availability of 10 commonly prescribed medications. RESULTS 1057/1058 pharmacies were contacted. All pharmacies had liquid formulations of oxycodone, hydrocodone, ibuprofen, acetaminophen, amoxicillin, and trimethoprim-sulfamethoxazole in stock. Liquid formulations of ciprofloxacin (10%) and oxybutynin (14.3%) were uncommonly stocked, while 92.5% of pharmacies stocked nitrofurantoin suspension, and 80.9% nitrofurantoin capsules. Statewide, 108 (10.2%) of pharmacies were closed on Saturdays and 297 (28.1%) closed on Sunday. More high (HPDC) than low population density (LPDC) (62.5% vs 0%, P < .001) and high-HI than low-HI counties (62.5% vs 0%, P = .30) had 24-hour pharmacies. A larger proportion of pharmacies were open 7-days in HPDC than LPDC (75.6% vs 56.2%, P < .0001) and in high-HI than low-HI counties (100% vs 62.5%, P = .30). The likelihood of a pharmacy being open 7 days/week was significantly higher in HPDC (vs LPDC; OR = 13.2, 95% CI: 4.39-39.7) and high-HI (vs low-HI; OR = 4.98, 95% CI: 2.58-9.60) counties. CONCLUSION Most pharmacies in Washington State carry medications commonly prescribed by pediatric urologists. However, retail pharmacy operating hours are widely variable and create geographic and temporal barriers in rural and poor areas that may limit the timely administration of prescription medication. Providers should consider a patient's practical ability to fill a prescription when starting a time-sensitive medication.
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Affiliation(s)
- Jorge A Whitley
- Division of Urology, Seattle Children's Hospital, Seattle, WA
| | - Kathleen Kieran
- Division of Urology, Seattle Children's Hospital, Seattle, WA; Department of Urology, University of Washington, Seattle, WA.
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Francone NO, Simon MA, Ortega P. Exploring Race and Ethnicity Representational Inequities in Illinois Medical Schools. Health Equity 2021; 5:526-533. [PMID: 34476326 PMCID: PMC8409236 DOI: 10.1089/heq.2021.0026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 01/27/2023] Open
Abstract
Purpose: Efforts to increase U.S. medical school student diversity have lagged behind the continued growth of racial/ethnic minorities in the population. A targeted, local approach may catalyze actionable change that holds schools accountable for addressing community needs through representation. The aims of our study are to (1) analyze the student racial/ethnic profiles of allopathic and osteopathic medical schools in the diverse state of Illinois and (2) compare student race/ethnicity with that of schools' local county and primary teaching hospital patient populations. Methods: Data from the Association of American Medical Colleges and American Association of College of Osteopathic Medicine were used to gather matriculated student race/ethnicity from the eight allopathic schools and one osteopathic medical school in Illinois. Representational inequity quotients (RIQs) were calculated to determine the proportion of Hispanic/Latinx, black/African American, and total underrepresented in medicine (UIM) individuals in three reference populations (U.S., county, and primary teaching hospital patient populations) relative to each medical school's student racial/ethnic profile. Results: Across Illinois schools, mean RIQs were highest (showed greater inequity) when county demographics were used as the reference population as opposed to U.S. or hospital populations. For all schools individually, Hispanic county-student RIQs were higher than RIQs based on hospital population. For a majority of schools with primary teaching hospital in Cook County, hospital-student RIQs magnified representational inequity for the black population. Conclusions: Using county data to evaluate medical school representation inequities may better reflect UIM representation goals than the U.S. population. Examining hospital demographics may further reveal other structural inequities relevant to medical education, such as primary teaching hospitals that are not adequately serving their surrounding communities. By evaluating RIQs on a local and hospital-population level, schools can periodically assess to what degree their student body and hospital populations represent their communities and adjust recruitment, retention, and service efforts.
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Affiliation(s)
- Nicolás O Francone
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Melissa A Simon
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois, USA
| | - Pilar Ortega
- Departments of Medical Education and Emergency Medicine, The University of Illinois College of Medicine, Chicago, Illinois, USA
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Willging CE, Jaramillo ET, Haozous E, Sommerfeld DH, Verney SP. Macro- and meso-level contextual influences on health care inequities among American Indian elders. BMC Public Health 2021; 21:636. [PMID: 33794816 PMCID: PMC8013166 DOI: 10.1186/s12889-021-10616-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 03/11/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND American Indian elders, aged 55 years and older, represent a neglected segment of the United States (U.S.) health care system. This group is more likely to be uninsured and to suffer from greater morbidities, poorer health outcomes and quality of life, and lower life expectancies compared to all other aging populations in the country. Despite the U.S. government's federal trust responsibility to meet American Indians' health-related needs through the Indian Health Service (IHS), elders are negatively affected by provider shortages, limited availability of health care services, and gaps in insurance. This qualitative study examines the perspectives of professional stakeholders involved in planning, delivery of, and advocating for services for this population to identify and analyze macro- and meso-level factors affecting access to and use of health care and insurance among American Indian elders at the micro level. METHODS Between June 2016 and March 2017, we undertook in-depth qualitative interviews with 47 professional stakeholders in two states in the Southwest U.S., including health care providers, outreach workers, public-sector administrators, and tribal leaders. The interviews focused on perceptions of both policy- and practice-related factors that bear upon health care inequities impacting elders. We analyzed iteratively the interview transcripts, using both open and focused coding techniques, followed by a critical review of the findings by a Community Action Board comprising American Indian elders. RESULTS Findings illuminated complex and multilevel contextual influences on health care inequities for elders, centering on (1) gaps in elder-oriented services; (2) benefits and limits of the Affordable Care Act (ACA); (2) invisibility of elders in national, state, and tribal policymaking; and (4) perceived threats to the IHS system and the federal trust responsibility. CONCLUSIONS Findings point to recommendations to improve the prevention and treatment of illness among American Indian elders by meeting their unique health care and insurance needs. Policies and practices must target meso and macro levels of contextual influence. Although Medicaid expansion under the ACA enables providers of essential services to elders, including the IHS, to enhance care through increased reimbursements, future policy efforts must improve upon this funding situation and fulfill the federal trust responsibility.
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Affiliation(s)
- Cathleen E. Willging
- Pacific Institute for Research and Evaluation, 851 University Blvd. SE, Suite 101, Albuquerque, NM 87106 USA
| | - Elise Trott Jaramillo
- Pacific Institute for Research and Evaluation, 851 University Blvd. SE, Suite 101, Albuquerque, NM 87106 USA
| | - Emily Haozous
- Pacific Institute for Research and Evaluation, 851 University Blvd. SE, Suite 101, Albuquerque, NM 87106 USA
| | - David H. Sommerfeld
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive (0812), La Jolla, San Diego, CA 92093-0812 USA
| | - Steven P. Verney
- Department of Psychology, University of New Mexico, MSC03-2220, Albuquerque, NM 87131-0001 USA
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